Kaiser Permanente is a titan of the managed health care industry. Established in 1945, it has grown to enormous proportions, serving approximately 9 million members through the efforts of 180,600 employees. Such gigantic proportions and wide arrays of services necessitate complex management. The organization has succeeded in establishing management that works "from the top down" with mixed results. Assessment of the Various Management Levels and Their Role in Kaiser Permanente

Kaiser Permanente is a managed care conglomerate initially developed in the 1930's and 1940's for construction, shipyard and steel mill employees, then opened to the public in October 1945 (Kaiser Permanente, 2012). Today Kaiser Permanente works as two partner organizations: Kaiser Foundation Health Plan, which is not-for-profit, and Permanente Medical Groups, which is for-profit (Kaiser Permanente, 2012). Based in Oakland, California, Kaiser boasts approximately 9 million members (Kaiser Permanente, 2012) and 180,600 employees (Kaiser Permanente, 2012).

Kaiser Permanente operates in 8 regions, including Northern California, Southern California, Colorado, Georgia, Hawaii, an area embracing Maryland, Virginia and Washington, DC, Ohio, and an area comprised of Oregon and Washington (Kaiser Permanente, 2012). In addition, Kaiser Permanente acts as "the caregiver, the hospital, the laboratory, and the pharmacy" (Kaiser Permanente, 2012). These extensive geographical and service categories require far-reaching corporate structures, topped by George C. Halvorson, its Chairman and CEO (Kaiser Permanente, 2012). In addition to its CEO, Kaiser Permanente's management structure includes: "Human Resources; Information Technology; Clinical Systems Support; Compliance; Health Plan Operations; Finance, Audit, Procurement; Communications; Community Benefit; Research and Health Policy; Legal; and Hospital Operations" (Kaiser Permanente, 2012). Those many areas are governed by a laundry list of executives, including: Bernard J. Tyson, President and chief operating officer; Jack Cochran, MD, FACS, Executive director, The Permanente Federation; Philip Fasano, Executive vice president and chief information officer; Kathy Lancaster, Chief financial officer and executive vice president of strategy; Arthur M. Southam, MD, Executive vice president, Health Plan Operations; Anthony A. Barrueta, Senior vice president, Government Relations; Raymond J. Baxter, PhD, Senior vice president, Community Benefit, Research and Health Policy; Chuck Columbus, Senior vice president and chief Human Resources officer; Amy Compton-Phillips, MD, Associate executive director, Quality, The Permanente Federation, LLC; Daniel P. Garcia, Senior vice president and chief compliance officer; Chris Grant, Senior...

(Hal) Wolf III, Senior vice president, chief operating officer, The Permanente Federation, LLCl; Scott Young, MD, Associate executive director, Clinical Care and Innovation, The Permanente Federation, LLC; Mark S. Zemelman
Senior vice president and general counsel (Kaiser Permanente, 2012).

Operating in a "top-to-bottom" management style, Kaiser Permanente also uses regional and medical facility management. In addition to its national corporate leadership team, the organization has a regional leadership team comprised of 8 regional presidents from all regions and 8 executive medical directors covering all regions (Kaiser Permanente, 2012). Kaiser's medical facilities also have their own management structures, consisting of a medical director, "middle management" and "frontline management" and "frontline staff" (Kaiser Permanente, 2011). Clearly, the organization employs an extensive, complex management system from the top down.

Description and Explanation of the External and Internal Environment of Kaiser Permanente

Kaiser Permanente's external environment certainly includes National Health Care Reform. Kaiser's official response is: "Universal access to high-quality, affordable health care coverage is imperative, and we are fully committed to working with policymakers to make that goal a reality" (Kaiser Permanente, 2012). In addition, a 1999 article that is admittedly too old yet outlines still significant external forces, states that the organization must deal with such external forces as: the power of large purchasers to force reductions in premiums; competition from HMOs; the aging of the population, rising costs of pharmaceutical agents and new technology; anti-HMO sentiment; and a significant increase in the number of individual consumers with limited dollars for purchasing health plans (Crosson, 1999).

The internal environment of Kaiser Permanente consists of the management systems and services mentioned above, as well as a corporate culture about which employees give mixed reviews. One anonymous employee stated, "At Kaiser Permanente, you job title is what you imagine it to be. Given the experience, education, and passion, there is room for growth for each individual. The union provides members with ample support to perform their job, seek funding for additional learning opportunities, or handle management complaints."…